Abstract Sun308: Outcomes of Extracorporeal versus conventional cardiopulmonary resuscitation for Cardiac arrest: A systematic review and metaanalysis of RCTs and Real World Studies

Background: Cardiac arrest is a major global health concern, contributing significantly to mortality rates. While conventional cardiopulmonary resuscitation (CPR) has long been the standard care approach, emerging research indicates that extracorporeal cardiopulmonary resuscitation (ECPR) may provide superior survival advantages. Studies suggest that timely application of ECPR can lead to improved outcomes, particularly in terms of survival rates and neurological recovery. The comparative efficacy of ECPR is further corroborated by various randomized controlled trials (RCTs), as well as retrospective and prospective studies. Search Methods: We conducted a comprehensive search of databases including PubMed, Google Scholar, Cochrane Library, PLOS One, ClinicalTrials.gov, and ScienceDirect from 2014 to 2025. Our analysis included 3 RCTs, 3 prospective, and 5 retrospective studies (n=154,216). Inclusion criteria involved patients undergoing cardiac arrest managed in inpatient or outpatient settings. Meta-analysis was performed using Review Manager (RevMan) version 5.4, calculating safety endpoints as odds ratios for ROSC, favorable neurological outcomes , and survival rates. Results: Findings indicated that ECPR was associated with a significantly higher rates of ROSC (OR 0.36, 95% CI [0.24–0.54], p<0.00001) and favorable neurological outcome (OR 0.47 , 95% CI [0.37–0.60], p<0.00001). The Survival at 6 months was significantly better in the ECPR group (OR 0.21, 95% CI [0.12–0.36], p<0.00001). Although CCPR showed higher odds for survival to ICU (OR 1.31, 95% CI [0.86–2.00], p=0.21) and discharge (OR 1.42, 95% CI [0.90–2.25], p=0.13), these did not reach statistical significance. Conclusion: ECPR shows improved ROSC and neurological outcomes over conventional CPR, with higher six-month survival rates, emphasizing the need to adopt ECPR in cardiac arrest management.